Examination of Proprioceptive Reliance During Backward Walking in Individuals With Multiple Sclerosis.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY Journal of Neurologic Physical Therapy Pub Date : 2024-10-17 DOI:10.1097/NPT.0000000000000497

Michael VanNostrand, Patrick G Monaghan, Nora E Fritz

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Abstract

Background: Slowed somatosensory conduction in multiple sclerosis (MS) increases postural instability and decreases proprioception. Despite these delays, individuals with MS rely more on proprioception for balance compared to controls. This heightened reliance, combined with slowed signal transduction, increases fall risk. Backward walking (BW) increases proprioceptive reliance by reducing visual cues. However, no study has conclusively linked proprioception to BW. This study aims to assess proprioception's role in BW compared to forward walking (FW) in MS and to compare differences in proprioception between MS fallers and non-fallers.

Methods: Fifty participants (average age: 50.34 ± 11.84, median Patient Determined Disease Steps [PDDS]: 2) completed the study. Participants completed BW and FW at comfortable and fast speeds. We have previously established vibration sensation as a proxy measure for proprioception. Vibration thresholds were quantified at the great toe bilaterally using a 2-alternative forced-choice procedure.

Results: Significant correlations were seen for vibration sensation and FW comfortable ( ρ = 0.35), FW fast ( ρ = 0.34), BW comfortable ( ρ = 0.46), and BW fast ( ρ = 0.46). After controlling for age, sex, and PDDS, vibration sensation significantly predicted performance during all walking tasks, with larger beta coefficients seen during BW (comfortable β = 0.57; fast β = 0.58) compared to FW (comfortable β = 0.41; fast β = 0.45). Fallers performed significantly worse than non-fallers for vibration sensation ( P = 0.04).

Discussion and conclusions: Considering the notable decrease in proprioception in participants with MS and the clear distinction between fallers and non-fallers, it is crucial to conduct fall risk assessments and interventions focusing on proprioception. With its heightened reliance on proprioception, BW offers a promising method for assessing fall risk and could be an effective exercise intervention.

Video Abstract available for more insights from the authors (see the Supplemental Digital Content available at: http://links.lww.com/JNPT/A490 ).

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多发性硬化症患者后退行走时本体感觉依赖的检查。

背景：多发性硬化症（MS）的体感传导减慢会增加体位不稳定性并降低本体感觉。尽管有这些延迟，与对照组相比，MS患者更多地依赖本体感觉来保持平衡。这种高度依赖，加上信号转导减慢，增加了跌倒的风险。后退行走（BW）通过减少视觉线索增加本体感觉依赖。然而，尚无研究将本体感觉与体重联系起来。本研究旨在评估本体感觉在多发性硬化症患者前体行走（FW）中的作用，并比较多发性硬化症患者和非患者本体感觉的差异。方法：50名参与者（平均年龄：50.34±11.84，中位患者确定疾病步骤[PDDS]: 2）完成研究。参与者以舒适和快速的速度完成BW和FW。我们之前已经建立了振动感觉作为本体感觉的替代测量。在双侧大脚趾处采用两种选择的强制选择程序量化振动阈值。结果：振动感觉与FW舒适（ρ = 0.35）、FW快速（ρ = 0.34）、BW舒适（ρ = 0.46）、BW快速（ρ = 0.46）有显著相关。在控制了年龄、性别和PDDS后，振动感觉显著预测了所有步行任务中的表现，其中BW的β系数更大(舒适β = 0.57；快速β = 0.58)，舒适β = 0.41；Fast β = 0.45)。跌倒者在振动感觉上的表现明显差于非跌倒者（P = 0.04）。讨论与结论：考虑到MS参与者本体感觉的明显下降，以及跌倒者和非跌倒者的明显区别，开展以本体感觉为重点的跌倒风险评估和干预至关重要。由于其高度依赖本体感觉，BW为评估跌倒风险提供了一种有希望的方法，可能是有效的运动干预。视频摘要可获得作者的更多见解（参见补充数字内容：http://links.lww.com/JNPT/A490）。

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来源期刊

Journal of Neurologic Physical Therapy CLINICAL NEUROLOGY-REHABILITATION

CiteScore

5.70

自引率

2.60%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Neurologic Physical Therapy (JNPT) is an indexed resource for dissemination of research-based evidence related to neurologic physical therapy intervention. High standards of quality are maintained through a rigorous, double-blinded, peer-review process and adherence to standards recommended by the International Committee of Medical Journal Editors. With an international editorial board made up of preeminent researchers and clinicians, JNPT publishes articles of global relevance for examination, evaluation, prognosis, intervention, and outcomes for individuals with movement deficits due to neurologic conditions. Through systematic reviews, research articles, case studies, and clinical perspectives, JNPT promotes the integration of evidence into theory, education, research, and practice of neurologic physical therapy, spanning the continuum from pathophysiology to societal participation.